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SPECT Imaging
Single-Photon Emission Computed Tomography

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Group 4
Christopher Emerson
Caterina Pette
Douglas Wright

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Contents
Advantages / Disadvantages
Medical / Non-Medical Applications
History
Modern Systems
Pricing
U.S. SPECT Statistics

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Advantages
Provides Physiological Information though Functional Imaging
Metabolic Activity
Blood Flow
Intrinsic Lesion Localization though Radiopharmaceutical Use
Radio-labeled ligans migrate to specific imaging site
3-D Imaging
Hybrid Imaging Systems provide Increased Spatial Resolution
SPECT/CT
http://xa.yimg.com/kq/groups/15914941/74581872/name/EJNMMI-SPECT%25EF%2580%25A2CT-Review.pdf,
“Advantages and disadvantages of PET and SPECT in a busy clinical practice” Timothy M. Bateman, MD

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Disadvantages
Gamma Emissions Harmful due to Ionization Potential
Non-Hybrid Devices have Poor Spatial Resolution
Tissue boundaries are ill-determined
Long Scan Time
Upwards of 30-40 minutes
Inconveniences certain patient populations
Use of Possible Allergens
Radiopharmaceuticals could induce allergic reactions
Intrinsic Reliance on Radiopharmaceuticals
Severe supply shortages can halt imaging
http://www.massgeneral.org/imaging/services/procedure.aspx?id=2255
http://blue.regence.com/trgmedpol/radiology/rad44.html

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Medical Applications
Myocardial Perfusion Imaging
Brain Perfusion
Thyroid Function
Renal Function
Bone Imaging
Myocardial Perfusion Imaging

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Myocardial Perfusion Imaging
Assessment of hemodynamic
consequences of Coronary Artery
Disease
Allows for risk stratification and pre-
surgical guidance
Determines ischemic myocardial
tissue though rest and stress
cardiac studies
Myocardial Perfusion Scan
Stress
Rest
http://eradiology.bidmc.harvard.edu/LearningLab/cardio/Furie.pdf

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Brain Perfusion
Pre-surgical localization of epileptic seizure origin
Technetium-99m labeled ECD or HMPAO injected at time of
seizure
Localize to region of increased blood flow
Images during and after seizure are compared to identify seizure
origin
http://my.clevelandclinic.org/Documents/Epilepsy_Center/PET%20and%20SPECT%20-%20Wu.pdf

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Thyroid Function
Thyroid tumor causes
increased metabolic activity
Localization achieved through
the use of Iodine-123 and
Iodine-131
Iodine-123: Routine testing for
hyperthyroidism and nodules
Iodine-131: Whole-body
imaging for detection of
metastasis
SPECT-CT shows metastasis
is localized in tip of transverse
process of the sixth thoracic
vertebra
A. Whole-body SPECT
B. Diagnostic CT
C. Fusion Image
http://www.ncbi.nlm.nih.gov/pubmed/1418597

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Renal Function
Renal lesions can result in elevated
levels of norepinehprine,
epinephrine, dopamine,
cathecholamines, and VMA
Localization achieved through the
use of Indium-111 Pentetreotide
SPECT scans revealed large right
suprarenal lesion
http://www.med.harvard.edu/JPNM/TF00_01/Sept19/WriteUp.html

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Bone Imaging
Early Detection of Osteonecrosis of the Femoral Head
http://jnm.snmjournals.org/content/43/8/1006/F1.expansion.html
A. Whole-body
scintigraphy
B. Bone SPECT
C. MRI Scan
A B show “cold”
areas in both
femoral heads
while C shows
normal findings

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Small Animal SPECT SPECT/CT Imaging
Used to determine drug efficacy in pre-clinical trials
http://jnm.snmjournals.org/content/49/10/1651/F5.expansion.html

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Non-Medical Applications
Detection of nuclear waste
Gamma cameras used to study the environmental behavior of nuclear
waste
Helps scientists monitor and control the spread of radioactivity
Fe(III)-reducing bacteria immobilizes technetium in sediment
http://www.bloomberg.com/news/2011-08-02/tepco-reports-second-deadly-radiation-reading-at-fukushima-plant.html

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Non-Medical Applications (cont.)
Detection of nuclear emission
Fukushima Nuclear Power Plant
Gamma cameras can be used to image radiation readings of wrecked
nuclear power plant
A photograph shows a gamma camera image of an area around the
main exhaust of Tokyo’s nuclear power plant detecting 5 Svt/hr.
http://www.bloomberg.com/news/2011-08-02/tepco-reports-second-deadly-radiation-reading-at-fukushima-plant.html
Tokyo Electric Power Co.'s (Tepco) Fukushima Dai-Ichi
nuclear power station in Fukushima, Japan, on
Monday, Aug. 1, 2011.
Soil Sampling

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History
1950s
1950s – 1960s
1960s – 1970s
1970s
Why the Delay?

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1950s
1896 – Antoine-Henri Becquerel discovers Radioactivity
Discovered that radiation from Uranium did not need any excitation
from an external energy source to emit radiation.
1934 – Frederic and Irene Joliot-Curie produce first artificial
radionuclide
Positron-emitting radionuclide of phosphorous
http://www.brainmattersinc.com/forphysicians/historyofspect.html
Antoine-Henri Becquerel
Irene Curie and Frederic Joliot
http://www.rtstudents.com/radiology/history-of-radiology.htm

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1950s
1943 – Gyorgy Hevesy develops radioactive tracers
Used to study the metabolic processes in plants and animals
1946 – Oak Ridge National Laboratory began production of
radionuclides for medical use
http://www.brainmattersinc.com/forphysicians/historyofspect.html
Gyorgy Hevesy
Oak Ridge National Laboratory
http://www.rtstudents.com/radiology/history-of-radiology.htm

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1950s – 1960s
1950 – Benedict Cassen assembled
the first automated scanning system
Motor-driven scintillation detector
coupled to a printer
1957 – Hal Oscar Anger develops
Anger Camera
Sodium-Iodine scintillation crystal
Vacuum tube photomultipliers
http://jnm.snmjournals.org/content/12/8/573.full.pdf
http://www.ncbi.nlm.nih.gov/pubmed/11155815
Benedict Cassen Hal Oscar Anger

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1960s – 1970s
Development of generator system to produce
Technetium-99m
Most utilized element in Nuclear Medicine
Employed in a wide variety of Nuclear
Medicine studies
Late 1963 – David E. Kuhl and Roy Q. Edwards
introduce emission and transmission tomography
Later developed into Single Photon Emission
Computed Tomography (SPECT)
Used 32 photon detectors
Images were frequently distorted and not of
diagnostic quality
http://www.news-medical.net/health/History-of-Nuclear-Medicine.aspx
http://www.uclimaging.be/ecampus/etu_med/option_2011/opt_2011_3120_mn.pdf
David Edmund Kuhl

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1970s
Late 1970s – Most organs of the body could be visualized with nuclear
medicine procedures
Liver, spleen, brain tumor localization, and gastrointestinal tract
1980s – Radiopharmaceuticals were designed for diagnosing heart
disease and cancer
1980s – Development of Monoclonal Antibodies
Act as cell-specific ligans that, when tagged with a radioisotope, localize
to a specific region of the body
Can detect cancerous cells before anatomical changes occur
http://interactive.snm.org/index.cfm?PageID=1107
http://www.news-medical.net/health/History-of-Nuclear-Medicine.aspx

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Radionuclide Specificity
www.themegallery.com

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Why the Delay?
The development of SPECT was slow due to a number of factors:
Image analysis algorithms were not advanced enough
Limited number of radionuclides available as tracers
Device size limited SPECT use outside of hospitals
Physicians were inexperienced reading SPECT images
Better late than never!
Advances in mathematics, innovations in radionuclide and ligand
development, and the advent of multi-modality imaging systems laid
the foundation for modern SPECT and SPECT/CT devices
http://www.imagingeconomics.com/issues/articles/MI_2004-06_02.asp
I wonder what
they exSPECT me
to see from this…

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Modern Systems
Leading Device Manufacturers
Brivo NM 615
Discovery NM 630
Discovery NM/CT 670
Ventri
Discovery NM 750b

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Leading Device Manufacturers
GE Healthcare
Siemens Healthcare
Philips Healthcare
Toshiba Medical Systems

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Brivo NM 615
Single-Headed System
Thin, Pivoting Gantry
5.12 m x 3.74 m x 2.30 m
500 lb Patient Limit
Increases patient population
Upright, chair, or stretcher imaging
Increases patient comfort
Elite NXT Detectors
Exceptionally High Count Rate
460k counts-per-second
SPECT-Optimized Collimators
Dose management
Reduce time or dose by 50%
Acquisition time rivals dual-headed systems
Auto-Body Contouring
Infra-red detectors minimize the distance
between the patient and the detectors
Xeleris 3 Workstation
http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/General_Purpose_Cameras/Brivo_NM615
http://www.gehealthcare.com/euru/clinical-education/images/december_newsletter/xeleris_3_460x260.jpg

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Brivo NM 615
http://www3.gehealthcare.com/~/media/Downloads/Product/Product-Categories/Nuclear-Medicine/General-Purpose-Scanners/Brivo-
NM615/GEHealthcare-Brochure_Brivo-NM-615.pdf?Parent={83A02FFC-6F7B-48B3-AB0F-AC550678E0B0}

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Discovery NM 630
http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/General_Purpose_Cameras/Discovery_NM_630
Upgrade from Brivo NM 615
Dual-Headed System
Cut imaging time or dose in half, again.
180°or 90°Orientations

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Discovery NM/CT 670
Upgrade from Discovery NM 630
IQ Enhance
Faster pitch helical scanning
Coverage equivalent to 50 slice
CT scans with same imaging
speed
16-minute bone protocol
BrightSpeed Elite CT Technology
Lower dose but maintained
quality
http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/SPECT-CT_Cameras/Discovery_NM-CT_670

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Discovery NM/CT 670
http://www3.gehealthcare.com/~/media/Downloads/Product/Product-Categories/Nuclear-Medicine/SPECT-
CT%20Scanners/GEHC-Brochure_%20Discovery_NM-CT-670.pdf?Parent={B5FEFEC2-711D-444A-AB1E-87EA682FB27C}

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Ventri
Originally Designed for Cardiac
Imaging
Restricted Imaging Range
Now offers Neurological Imaging
Smaller Office Footprint
Less expensive
Similar Technology as Larger
Devices
http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/Cardiac_Cameras/Ventri

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Ventri
http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/Xeleris_3/Evolution_for_Cardiac

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Discovery NM 750b
Dedicated Breast Imaging
Solid-state Cadmium Zinc Telluride
Detectors
3 times the imaging sensitivity of
conventional NaI gamma cameras
Degradation-free Uniformity across entire
Field-of-View
Overcomes Breast Density challenges
Single or Dual-Head Configuration
MLO = Mediolateral Oblique View
CC = Cranio – Caudal View
http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/Discovery_NM-CT_750b

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Pricing
Total Price
Device
Imaging
Influential
Circumstances

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Imaging
Base Imaging Cost
Radiopharmaceuticals Used
Interpretation by Radiologist
Organ Price
Bone Imaging Scan: $585.20
Radiopharmaceutical: $62.35
Liver / Spleen Imaging Scan: $993.30
Radiopharmaceutical: $77.90
Brain Imaging Scan: $809.75
Renal Imaging Scan: $996.08
Joint Imaging Scan: $1016.00
Myocardial Perfusion Imaging Scan: $2902.00
http://outofpocket.com/OOP/Default.aspx?q=SPECTcx=015166729515697606531%3a3sy7u0rpz2ocof=FORID%3a9

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Device
Device Cost
Multi-Headed, New : $400,000
Multi-Headed, Refurbished: $100,000
Utility Costs
Powering the Device and Control Station
Powering the Electronics in the Imaging
Suite
Wages of Employees
Radiology Technicians
Maintenance Personnel
Sanitation Personnel
Hardware Updates
Software Updates
http://www.ibh.com/SPECT-ComplexCases.pdf

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Influential Circumstances
Age of Imaging System
Recently Purchased
Hospital may charge more till it breaks even
Post Breaking-Even
Hospital may charge less since device has
“paid-for-itself”
Neighboring Hospital Competition
Rich Competition
May charge less to attract more customers
Poor Competition
May charge more to capitalize on pseudo-
monopoly
Pending Lawsuits

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U.S. SPECT Statistics
Imaging Locations and Frequency
Installed Devices and Patient Waiting Times
Projected Purchases

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Imaging Locations and Frequency
~ 17 million Nuclear Medicine procedures performed at 7,230
different sites in 2010
Procedure frequency decreased by 0.5% each year from 2007 to 2010
87% of procedures conducted in nonhospital locations are
cardiovascular studies
47% of procedures conducted in hospital locations are cardiovascular
studies
More likely to be conducting other procedures including bone scans, liver,
renal, respiratory, infection/abscess, and tumor localization studies.
1/3 of Nuclear Imaging sites are physician office locations
Includes cardiology offices, multispecialty clinics, and imaging centers
~ 25% of imaging sites provide neurology applications
Projected to grow to 1/3 of sites by 2013
Driven by development of radiopharmaceuticals to address Parkinson's
disease
http://www.auntminnie.com/index.aspx?sec=vdpsub=defpag=disitemId=96830
http://184.107.144.35/pressreleases/imv-nuclear-medicine-report-shows-nuclear-medicine-procedure-volume-flat-from-2007-to-2010.html

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Installed Devices and Patient Waiting Times
Dual-head SPECT installations comprise 64% of the gamma
camera installed base
Down from 70% in 2008
SPECT/CT camera installed base increased from 2% of the
installed base in 2008 to 9% in 2011
69% of the SPECT/CT and SPECT camera installed base are
considered to be general purpose
31% are dedicated cardiac cameras
Patient waiting times for nuclear imaging procedures have
decreased
Waiting times of 1+ days for scheduled outpatient procedures
decreased from 77% of the sites in 2003 to 43% of the sites in 2011
http://184.107.144.35/pressreleases/imv-nuclear-medicine-report-shows-nuclear-medicine-procedure-volume-flat-from-2007-to-2010.html
http://www.auntminnie.com/index.aspx?sec=vdpsub=defpag=disitemId=96830

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Projected Purchases
Estimated replacement time of 12.8 years for a typical gamma
camera
85% of purchases are replacements
1 in 6 planned camera purchases through 2013 will be from
physician offices
~ 50% are Dual-head SPECT cameras
33.33% are SPECT/CT systems
Gaining momentum
http://184.107.144.35/pressreleases/imv-nuclear-medicine-report-shows-nuclear-medicine-procedure-volume-flat-from-2007-to-2010.html
http://www.auntminnie.com/index.aspx?sec=vdpsub=defpag=disitemId=96830

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